Although Partial and Total Knee Replacement (TKR) are both considered to be successful in the treatment of end stage osteoarthritis, they may not be routinely offered to the very elderly over fears of increased mortality and complication rates.¹ This retrospective analysis compared complication rates, mortality, functional outcomes (Oxford Knee Score), and quality adjusted life years (QALYs) in a cohort of patients aged > 83 years at the time of their primary knee surgeries.¹

It included all patients meeting the age criteria that received a primary PKR or TKR for advanced symptomatic OA between September 2009 and February 2019.¹ The average age in the PKR group was 85.9 years compared to 85.2 years in the TKR group.¹

The authors observed that:

• There were no significant differences in patient characteristics or functional scores between the groups¹
• The average operating time was significantly lower in the PKR group¹
• The surgical-related complication rate requiring re-operation 
was 4.3% in PKR Vs 9.7% in TKR¹
• The medical complication rate was 4.3% in PKR Vs 8.1% in TKR¹
• The Kaplan-Meier one-year survival estimate was 98.8% in PKR Vs 98.4% in TKR¹
• OKS improved from 23 to 40 points in the PKR group and 19 to 41 points in the TKR group¹

The authors concluded that “patients should not be excluded from knee replacement based on their age alone, but careful patient selection, peri- and post-operative optimisation, and awareness of complications are essential for successful treatment.”¹ For suitable patients, PKR should be preferred over TKR as the complication rate is significantly lower.”¹